Tuesday, 25 August 2015

Singer on organ morals

One of the key contributors to low donation rates is the fact up to 50 per cent of families, when asked, say "no" to a donation request. In our view, despite the difficult emotional circumstances, this is a gross ethical failing. When the cost to a person of performing some moral action is small, and the benefit to others is great, there is a duty of easy rescue to provide that benefit. When you can save a life with a unit of blood, you have a moral obligation to give that unit. Donating organs after death is the easiest rescue of all, because there is no cost to giving organs in these circumstances. We don't need them, and they will otherwise be buried or cremated. Because a single donor can provide organs and tissue that benefit up to 10 other people, to choose not to donate is to allow those individuals to unnecessarily die or continue to suffer.

He recommends shifting to an opt-out system and allowing binding registries blocking family over-ride. But unless doctors also shift to then either not consulting with families or ignoring family objections, or unless doctors combine opt-out with fairly rigorous exhortation of donors' families to allow donation (as is the case in Spain), it won't do as much good as Singer and I might hope. There's also the risk that binding registries might do as much to block families from opting somebody in as they would to prevent families from opting you out.

I agree entirely with Singer here:

Third, we should consider providing incentives to individuals and families to encourage them to donate. Last year, a group of leading medical specialists, bioethicists, religious leaders, economists and others sent an open letter to United States President Barack Obama suggesting that pilot programs should test whether regulated benefits to living donors – including financial incentives such as payments into their superannuation funds – would increase the supply of kidneys in ways that safeguard the rights and health of donors. For deceased donors, incentives could include financial contributions to funeral expenses – just as many universities offer free ceremonies and cremation for those who donate their bodies to medical research.Incentive policies could also be non-financial. One promising idea is offering prioritisation in the receipt of organs for those who sign up as donors without the possibility of family veto. Israel adopted such an approach in 2012, but it also exists in Singapore and the US (for living donors). Such an approach can operate on a points-based system – awarding additional points to willing donors, while still taking account of other factors, such as time on the waiting list and medical need. If this approach worked to increase supply, then everyone who needs an organ – even those who choose not to sign up – may benefit. A rising tide can lift all boats.

Becker and Elias found that about $15,000 in compensation would provide the United States with as many live kidney donors as would be required to solve the shortage. And while results on Israel's priority system for cadaveric donation have been less than conclusive, giving live donors priority while providing them compensation seems to have increased donation rates.